Group Accident Insurance

STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED
Regd. & Corporate Office : 1, New Tank Street, Valluvar Kottam High Road,
Nungambakkam, Chennai - 600 034. Phone : 044 - 2828 8800
CIN : L66010TN2005PLC056649 Email : [email protected] Website : www.starhealth.in IRDAI Regn. No : 129
GROUP ACCIDENT INSURANCE POLICY

Unique Identification No.: SHAHLGP18123V011718
A. PREAMBLE
The Company by this Policy agrees, subject to the terms, conditions and exclusions as set out and the
Schedule with all its Parts, that on proof to the satisfaction of the Company, of the compensation having
become payable, as set out in the Schedule, upon the happening of an event, to pay the Sum Insured/
appropriate Benefit
B. DEFINITIONS
In this Policy, the following words and expressions shall have the following meanings, as set forth, unless the
context otherwise requires:
Standard Definitions
Accident: An accident means sudden, unforeseen and involuntary event caused by external, visible and violent
means.
Condition Precedent: Condition Precedent means a policy term or condition upon which the Insurer's liability
under the policy is conditional upon.
Hospital: A hospital means any institution established for in-patient care and day care treatment of illness
and/or injuries and which has been registered as a hospital with the local authorities under Clinical
Establishments (Registration and Regulation) Act 2010 or under enactments specified under the Schedule of
Section 56(1) of the said act Or complies with all minimum criteria as under:
i) has qualified nursing staff under its employment round the clock;
ii) has at least 10 in-patient beds in towns having a population of less than 10,00,000 and at least 15 in-
patient beds in all other places;
iii) has qualified medical practitioner(s) in charge round the clock;
iv) has a fully equipped operation theatre of its own where surgical procedures are carried out;
v) maintains daily records of patients and makes these accessible to the insurance company’s authorized
personnel;
Injury: Injury means accidental physical bodily harm excluding illness or disease solely and directly caused by
external, violent, visible and evident means which is verified and certified by a Medical Practitioner.
i) must not exceed the level of care necessary to provide safe, adequate and appropriate medical care in
scope, duration, or intensity;
ii) must have been prescribed by a medical practitioner;
iii) must conform to the professional standards widely accepted in international medical practice or by the
medical community in India.
Notification of Claim: Notification of claim means the process of intimating a claim to the insurer or TPA
through any of the recognized modes of communication.
OPD treatment: OPD treatment means the one in which the Insured visits a clinic / hospital or associated
facility like a consultation room for diagnosis and treatment based on the advice of a Medical Practitioner. The
Insured is not admitted as a day care or in-patient.
Pre-Existing Disease: Pre-existing Disease means any condition, ailment, injury or disease:
a) That is/are diagnosed by a physician within 48 months prior to the effective date of the policy issued by
the insurer or its reinstatement
or
Policy Wordings Group Accident Insurance Policy Unique Identification No.: SHAHLGP18123V011718 1
b) For which medical advice or treatment was recommended by, or received from, a physician within 48
months prior to the effective date of the policy issued by the insurer or its reinstatement
Specific Definitions
Age: Age means the age of the insured person on his/her completed years as recent birthday as per the
English Calendar
Clinic: Clinic means a medical establishment where patients are given medical treatment or advice
Company: Company means Star Health and Allied Insurance Company Limited
Day: Day means a period of 24 consecutive hours
Dependent Child: Dependent Child means a child (natural or legally adopted), who is financially dependent
on the insured person does not have his / her independent sources of income.
Grievous Injury: Grievous Injury means emasculation, permanent privation of the sight of either eye,
permanent privation of hearing of either ear, privation of any member or joint, destruction or permanent
impairing of the powers of any member or joint, permanent disfiguration of head or face, fracture or dislocation of
a bone or tooth.
Group Administrator: Group Administrator means the proposer / insured mentioned in the policy schedule
Hazardous Sport / Hazardous Activities: Hazardous Sport / Hazardous Activities means engaging whether
professionally or otherwise in any sport or activity, which is potentially dangerous to the Insured Person
(whether trained, or not). Such Sport/Activity including but not limited to Winter sports, Ice hockey, Skiing,
Skydiving, Parachuting, Ballooning, Scuba Diving, Bungee Jumping, Mountain Climbing, Riding or Driving in
Races or Rallies, caving or pot holing, hunting or equestrian activities, diving or under-water activity, rafting or
canoeing involving rapid waters, yachting or boating outside coastal waters, jockeys, horseback, Polo, Circus
personnel, army/navy/air force personnel and policemen whilst on duty, persons working in underground
mines, explosives, magazines, workers whilst involved in electrical installation with high-tension supply, nuclear
installations, handling hazardous chemicals.
Insured Person: Insured Person means the name/s of persons shown in the schedule of the Policy.means
the name/s of persons shown in the schedule of the Policy.
Necessary and Reasonable Medical Expenses: Necessary and Reasonable Medical Expenses means the
charges for services or supplies, which are the standard charges for the specific provider and consistent with
the prevailing charges in the geographical area for identical or similar services, taking into account the nature
of the illness / injury involved
Nuclear, chemical, biological terrorism: Nuclear, chemical, biological terrorism shall mean the use of any
nuclear weapon or device or the emission, discharge, dispersal, release or escape of any solid, liquid or
gaseous Chemical agent and/or Biological agent during the period of this insurance by any person or group(s) of
persons, whether acting alone or on behalf of or in connection with any organisation(s) or government(s),
committed for political, religious or ideological purposes or reasons including the intention to influence any
government and/or to put the public, or any section of the public, in fear. “Chemical” agent shall mean any
compound which, when suitably disseminated, produces incapacitating, damaging or lethal effects on people,
animals, plants or material property. “Biological” agent shall mean any pathogenic (disease producing) micro-
organism(s) and/or biologically produced toxin(s) (including genetically modified organisms and chemically
synthesized toxins) which cause illness and/or death in humans, animals or plants.
Permanent Partial Disablement: Permanent Partial Disablement means Medical Practitioner certified total
loss or loss of use of specific body part as detailed under “Permanent Partial Disablement - Benefit 3 ”
following accidental injury to the insured person
Permanent Total Disablement: Permanent Total Disablement means the insured person, following accidental
injuries is unable to engage in each and every occupation or employment for compensation or profit for which
he is reasonably qualified by education, training or experience for the rest of his life. If at the time of loss the
insured person is unemployed, Permanent Total Disablement shall mean the total and permanent inability to
perform all of the usual and customary duties and activities of a person of like age and sex even with the use of
special equipment routinely available to help and having taken any appropriate prescribed medication
Policy: Policy means the Policy Wordings, the Policy Schedule and any other endorsements if any. No change
in this Policy shall be valid until approved by Our authorized officer and such approval is endorsed hereon
Proposal Form / Declaration Form: Proposal Form / Declaration Form means any initial or subsequent
declaration made by Policy Holder / Insured
Relative: Relative means spouse, children, parents, siblings or in-laws
Risk Group : Risk Group I- Persons engaged primarily in administrative functions
Risk Group II - Persons engaged in manual work other than what is specifically provided for under Group III
Risk Group III – Persons working in explosives industry, mine and /or Magazine workers, high tension electric
supply, horse racing including jockeys, athletes and occupations of similar hazard.
Standard type aircraft/Sea Craft: Standard type aircraft/Sea Craft means an aircraft/sea-craft duly licensed to
carry passengers (for hire or otherwise) by appropriate authority irrespective of whether such an aircraft is
privately owned or charted or operated by a regular airline.
Sum insured: Sum insured means the amount of insurance for which the premium is paid.
Temporary Total Disablement: Temporary Total Disablement means the Insured Person is totally disabled
from engaging in any occupation or business for a temporary period following a Grievous injury arising solely
and directly from an accident
Important: It is mandatory that the insured should choose at-least one of the following benefits:-
1. Accidental Death – Benefit 1
2. Permanent Total Disablement - Benefit 2
C. SCOPE OF COVER
The Company hereby agrees, subject to the terms, conditions and exclusions herein contained or otherwise
expressed herein, to pay to the Insured person or his nominees or his legal heirs, a sum as compensation for
any loss occurring during the Period of Insurance as described under different section hereunder, and as
specified in the Schedule to the Policy.
Geographical Scope: The insurance cover applies Worldwide unless otherwise stated
Accidental Death - Benefit 1
The Company will pay as hereinafter mentioned:
If at any time during the Period of Insurance, the Insured Person shall sustain any bodily injury resulting solely
and directly from Accident, and such accident causes death of the Insured Person within 12 Calendar months
from the date of Accident, then the Company will pay an amount as provided in “Benefit 1” under “Schedule of
Benefits”
Permanent Total Disablement - Benefit 2
If following an Accident which caused permanent total impairment of the Insured’s physical capabilities, then
the Company will pay the benefits as provided in “Benefit 2” under “Schedule of Benefits” depending upon the
degree of disablement provided that:
a) The disablement occurs within 12 Calendar months from the date of the Accident.
b) The disablement is confirmed and claimed for, prior to the expiry of a period of 60 days since occurrence
of the disablement.
Provided always that the policy will not pay under more than one of the Benefits stated under “Schedule of
Benefits” in respect of the same Accident.
Permanent Partial Disablement - Benefit 3
If following an Accident which caused permanent partial impairment of the Insured’s physical capabilities, then
the Company will pay the benefits as provided in “Benefit 3” under “Schedule of Benefits”, depending upon the
degree of disablement provided that:
a) The disablement occurs within 12 Calendar months from the date of the Accident.
b) The disablement is confirmed and claimed for, prior to the expiry of a period of 60 days since occurrence
of the disablement.
Provided always that the policy will not pay under more than one of the Benefits stated under “Schedule of
Benefits” in respect of the same Accident In case of multiple disability from the same accident, the policy will
pay the highest of the compensation.
Temporary Total Disablement (Weekly Compensation) - Benefit 4: If at any time during the period of
insurance the insured person/s shall sustain Grievous injury arising solely and directly from an accident and
resulting in admission in a Hospital / Nursing Home as an in-patient, then the insured person will be paid a
sum calculated at 1% of the sum insured under Benefit 4 per completed week but not exceeding the amount
stated in the schedule per completed week, in all, under all Personal Accident policies, if such injury be the
sole and direct cause of Temporary Total Disablement.
This benefit is subject to a maximum period of 100 weeks or the number of weeks stated in the schedule
whichever is less from the date of such Temporary Total Disablement
In no case shall the compensation exceed the sum insured for this benefit. The payment shall be made only
after the termination of such disablement.
All the benefit under this section is subject to exclusions, as mentioned in ‘General Exclusions’ of this Policy
Special Conditions (applicable to Benefits)
1. If the Accident affects any physical function, which was already impaired prior to the accident, a deduction
as recommended by our panel Doctor will be made in respect of this prior disablement.
2. If the accident impairs a number of physical functions, the degree of disablement given in the Schedule
of Benefits will be added together, but liability in any case shall not exceed 100% of the Sum Insured.
3. Where a claim for 100% of the Sum Insured is admitted / admissible the coverage under the policy ceases
for such relevant person.
4. Where a claim for less than 100% of the Sum Insured is admitted / admissible, the coverage under the
policy will continue until expiry for the balance sum insured and Company would exclude such disability
on renewal in respect of such relevant person if the group policy is renewed
5. In the event of Permanent Disablement, the Insured Person will be under obligation:
a) To have himself/herself examined by doctors appointed by the Company/ and the Company will pay
the costs involved thereof.
b) To authorize doctors providing treatments or giving expert opinion and any other authority to supply
the Company any information that may be required. If the obligations are not met with due to
whatsoever reason, the Company may be relieved of its liability to pay. Provided however the insured
shall be deemed to have discharged his duties/obligations if he authorizes / gives consent to the
treating doctor/s or the experts who gave opinion. Any subsequent failure on the part of the treating
doctor/experts who gave opinion / hospital will not be held up against the insured.
Exclusions (applicable to all Benefits)

(a) Any payment in case of more than one claim under the policy during the period of insurance by which the
maximum liability of the Company in that period would exceed the Sum Insured.
(b) Any other claim after a claim has been admitted by the Company and becomes payable for Death or
100% Permanent Total Disablement.
(c) Any claim arising out of pregnancy or childbirth, infirmity, whether directly or indirectly
D. OPTIONAL COVERS (Available only if specifically opted and shown in the policy schedule)
1. AMBULANCE CHARGES / TRANSPORTATION EXPENSES OF MORTAL REMAINS: Following an
admissible claim under the policy due to an Accident outside the place of the insured’s residence, the
Company shall pay up to limits mentioned in the schedule during the policy period
Either
a) Towards ambulance charges for emergency treatment to go to the hospital in case of injury Or
in case of Death
b) Towards transportation of the mortal remains of the insured person (including the cost of embalming
and coffin charges) to the residence of the insured,
This lump sum amount is payable in addition to the sum insured
2. TRAVEL EXPENSES FOR ONE RELATIVE: Following an admissible claim under the policy towards
Death of the Insured Person due to an Accident, outside the place of his/her residence, the Company will
pay up to the limits mentioned in the schedule for the transport expenses to one relative of the Insured
Person.
This amount is payable in addition to the sum insured
3. PURCHASE OF BLOOD: The Company will pay up to the limits mentioned in the schedule towards the
expenses incurred in purchasing blood through a Hospital or Government approved blood bank for the
purpose of the Insured Person’s medical or surgical treatment provided there is an admissible claim under
this policy.
4. TRANSPORTATION OF IMPORTED MEDICINES: The Company will pay up to the limits mentioned in
the schedule towards the expenses incurred on freight charges for importing medicines to India, provided
that:
a. There is an admissible claim under the policy.
b. The medicines, formulations or alternatives of the imported medicines are not available in India, and
c. The medicines are necessary for the medical/surgical treatment of the Insured person in a Hospital
following the Accident.
d. The medicines which are imported should be permissible under Government Regulation
e. The medicines shall not include any drugs under clinical trial or medicines, formulations or molecules
of unproven efficacy.
f. Prescription of the treating doctor with confirmation that the medicine is not available in India This
amount is payable in addition to the sum insured
5. MEDICAL EXPENSES FOLLOWING AN ADMISSIBLE PERSONAL ACCIDENT CLAIM: This insurance
is extended to pay any necessary and reasonable medical expenses incurred and expended by the
Insured Person arising solely and directly as a result of accident up to the limits mentioned in the schedule
subject to exclusions mentioned in the General Exclusion of this policy. Sufficient proof for the treatment
taken to be submitted to the Company

The benefits under this extension is optional and is effective only if
1. There is an admissible claim under Accidental Death - Benefit 1 / Permanent Total Disablement -
Benefit 2 / Permanent Partial Disablement - Benefit 3 /Temporary Total Disablement (Weekly
Compensation) - Benefit 4
2. Medical expenses incurred / expended during the policy tenure and are payable only if the policy is
in force.
3. Treatment availed is not an unproven / Experimental Treatment
4. Treatment is taken in a clinic / nursing home or hospital (except for physiotherapy done at home)
6. MEDICAL EXPENSES IRRESPECTIVE OF AN ADMISSIBLE PERSONAL ACCIDENT CLAIM: This
insurance is extended to pay any necessary and reasonable medical expenses incurred and expended
by the Insured Person arising solely and directly as a result of accident up to the limits mentioned in the
schedule subject to exclusions mentioned in the General Exclusion of this policy. Sufficient proof for the
treatment taken to be submitted to the Company
The benefits under this extension is optional and is effective only if
1. Medical expenses incurred / expended during the policy tenure and are payable only if the policy is
in force.
2. Treatment availed is not an unproven / Experimental Treatment
3. Treatment is taken in a clinic / nursing home or hospital (except for physiotherapy done at home).
7. HOME CONVALESCENCE: Following an admissible claim for Permanent Total Disability / Permanent
Partial disability under the policy, the Company will pay the cost of engaging one attendant at residence
immediately after discharge from the hospital provided the same is recommended by the attending
physician. Such expenses are payable up-to the limits mentioned in schedule. No payment will be made
for the first day.
This benefit is payable in addition to the sum insured
8. HOSPITAL CASH BENEFIT: Following an admissible claim under the policy the Company will pay up to
the limits mentioned in the schedule for each completed day of hospitalization. This benefit is subject to
a time excess of 24hours
No claim under this head shall lie with the Company where the admission is for physiotherapy and/or any
epidemic
This benefit is payable in addition to the sum insured
9. VEHICLE AND/OR RESIDENCE MODIFICATION: The Company will pay upto 10% of the sum insured
subject to the limits mentioned in the schedule towards the expenses incurred to modify the Insured
Person’s residential accommodation or vehicle as long as the modification have been carried out in India
and certified by a Doctor to be necessary and directly required as a result of the Accident for which there
is an admissible claim under Permanent Total Disablement - Benefit 2 under this certificate of insurance
10. EXTERNAL SUPPORT TO THE INSURED PERSON: This insurance is extended to pay for the cost of
crutches / walkers / artificial limbs / wheel chair incurred by the Insured Person arising solely and directly
as a result of accident up to the limits mentioned in the schedule subject to exclusions mentioned in the
General Exclusion of this policy. Sufficient proof of accident with respective bills, invoices, payment
receipts and such other documents should be submitted to the Company
The benefits under this extension is optional and is effective only if there is an admissible claim under the
policy for Permanent Total Disablement - Benefit 2
11. FUNERAL EXPENSES: Following an admissible claim towards death of the insured person due to an
accident, the Company shall pay up to the limits mentioned in the schedule towards funeral expenses of
the insured person.
Sufficient bills, invoices, payment receipts and such other documents should be submitted to the
Company
12. EDUCATIONAL BENEFIT IN CASE OF ACCIDENTAL DEATH / PERMANENT TOTAL DISABILITY OF
THE INSURED PERSON:
Following an admissible claim under the policy towards Accidental Death - Benefit 1 / Permanent Total
Disablement - Benefit 2 of the insured person, the Company will pay Educational Benefit for a maximum
of two dependent children of the Insured, as mentioned below:
 If the Insured Person has dependent child/children below the age of 23 years, an amount as stated
in the schedule is payable.
13. EDUCATIONAL BENEFIT IN CASE OF ACCIDENTAL DEATH / PERMANENT DISABILITY OF
PARENT/S OR GUARDIAN OF THE INSURED PERSON (WHERE THE INSURED PERSON IS A
SCHOOL OR COLLEGE STUDENT)
Following Accidental Death / Permanent Total Disability of the parent or guardian (named in the schedule)
of the insured person, the Company will pay Educational Benefit as stated in the Schedule as
compensation
This benefit is payable in addition to the sum insured.
Note: Claim is payable only either under optional benefit 12 or 13 but not under both
14. OUT PATIENT MEDICAL EXPENSES DUE TO GRIEVOUS INJURY: This insurance is extended to pay
necessary and reasonable Out Patient Medical Expenses incurred and expended by the Insured Person
arising solely and directly as a result of accident resulting in Grievous Injury up to the limits mentioned
in the schedule subject to exclusions mentioned in the General Exclusion of this policy. Sufficient proof for
the treatment taken to be submitted to the Company
Note: Medical expenses incurred / expended are during the policy tenure and are payable only if the
policy is in force.
E. GENERAL EXCLUSIONS (APPLICABLE TO ALL BENEFITS AND OPTIONAL COVERS OF THIS POLICY):
The Company shall not be liable to make any payments in respect of:
1. Any claim relating to events occurring before the commencement of the cover or otherwise outside the
Period of Insurance.
2. Any claim in respect of Pre-existing conditions.
3. Any claim if the insured acts against the advice of a physician.
4. Any claim arising out of Accidents that the Insured Person has caused
a. intentionally or by committing a crime or
b. as a result of drunkenness or addiction (drugs, alcohol). or
c. self-endangerment unless in self-defense or to save human life.
5. Any claim arising out of mental disorder, suicide or attempted suicide self inflicted injuries, or sexually
transmitted conditions, anxiety, stress, depression, venereal disease or any loss directly or indirectly
attributable to HIV (Human Immunodeficiency Virus) and / or any HIV related illness including AIDS
(Acquired Immunodeficiency Syndrome), insanity and / or any mutant derivative or variations thereof
howsoever caused.
6. Insured Person engaging in Air Travel unless he/she flies as a fare-paying passenger on a Standard type
aircraft properly licensed to carry passengers. For the purpose of this exclusion Air Travel means being
in or on or boarding an aircraft for the purpose of flying therein or alighting there from.
7. Accidents that are results of war and warlike occurrence or invasion, acts of foreign enemies, hostilities,
civil war, rebellion, insurrection, civil commotion assuming the proportions of or amounting to an uprising,
military or usurped power, seizure capture arrest restraints detainments of all kings princes and people of
whatever nation, condition or quality whatsoever.
8. Participation of the Insured Person in riots, confiscation or nationalization or requisition of or destruction
of or damage to property by or under the order of any government or local authority.
9. Any claim resulting or arising from or any consequential loss directly or indirectly caused by or contributed
to or arising from:
a) Ionizing radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste
from the combustion of nuclear fuel or from any nuclear waste from combustion (including any self
sustaining process of nuclear fission) of nuclear fuel.
b) Nuclear weapons material
c) The radioactive, toxic, explosive or other hazardous properties of any explosive nuclear assembly or
nuclear component thereof.
d) Nuclear, Chemical, biological terrorism
10. Any claim arising out of sporting activities in so far as they involve the training or participation in
competitions of professional or semi-professional sports persons.
11. Participation in Hazardous Sport / Hazardous Activities
12. Any loss of which a contributing cause was the Insured Person’s actual or attempted commission of or
willful participation in an illegal act or any violation or attempted violation of the law.
F. GENERAL CONDITIONS (APPLICABLE TO ALL BENEFITS AND OPTIONAL COVERS OF THIS POLICY)
The conditions below apply throughout this insurance. Failure to comply with them may be prejudicial to a claim:
1. Obligations of the Insured Person / Group Administrator / Proposer: Intimation about an event or
occurrence that may give rise to a claim under this policy must be given within 30 days of its happening.
Claims for insurance benefits must be submitted to the Company not later than one (1) month after the
completion of the treatment or after transportation of the mortal remains/ burial in the event of Death.
Note: For assistance call 24 hours help-line 044-69006900 or Toll Free No. 1800 425 2255, Senior
Citizens may call at 044-40020888
This condition is precedent to admission of liability under the policy. However the Company will examine
and relax the time limit mentioned in this condition depending upon the merits of the case
2. Notification of Claim: Where the claim intimation is received by the call centre/Corporate office details
as to coverage is collected.
Documents to be submitted for claims:
Duly completed claim form, copy of PAN Card and Aadhar Card of the Insured Person Nominee / Legal
Heir as the case may be
and
For Death Claims
 Death Certificate
 Post-mortem Certificate, if conducted
 FIR (wherever required)
 Police Investigation report / Panchanama (wherever required)

 Viscera Sample Report / Chemical analysis report (wherever required)
 Forensic Laboratory Report (wherever required)
 Legal Heir Certificate (wherever required)
 Succession Certificate (wherever required)
For Permanent Total Disablement - Benefit 2 and Permanent Partial Disablement - Benefit 3
 Certificate from Government doctor not below the rank of Civil Surgeon, confirming the disability and its %.
Note: The Company authorized doctor may examine the insured person/s if required
For Temporary Total Disablement (Weekly Compensation) - Benefit 4
 Certificate from the employer confirming leave of absence from duty (applicable for employer –
employee group)
 Certificate from the treating doctor that the claimant is fit to resume duty (fitness certificate)
Travel expenses for one relative
 Proof of expenses incurred (original)
Vehicle and/or residence modification
 Certificate from the doctor confirming the Disability and the requirement of modification
 Estimate from Workshop
 Invoice and Cash receipt for having carried the modification
 Estimate from civil engineer
 Invoice / Cash receipt for completion of the civil work modification
Purchase of blood:
 Original receipt for purchase of blood (wherever applicable)
Transportation of imported medicines:
 Prescription of the treating doctor with confirmation that the medicine is not available in India.
 Original receipt for the freight incurred for import of the medicine, along with a copy of invoice
Ambulance charges / transportation expenses of mortal remains
 Death Certificate or
 Proof of hospitalisation
 Proof of utilized services of either Ambulance or Mortuary Van (Original Receipt)
Medical expenses due to accident:
 Original Discharge Summary (wherever applicable)
 Original Medical Reports
 Original Invoices/Bills,
 Original Payment Receipts
Hospital Cash and Home Convalescence
 Discharge Summary (Where original is required for other purposes, a certified copy may be
submitted)
 Recommendation by the treating doctor for appointing an attendant at home for continuation of treatment.
 Cash receipt for payment made to the attendant
Educational Benefit
 Death certificate of Parent/s or Guardian
 Age proof of the student
 Proof of education.
Note: The Company reserves the right to call for additional documents wherever required.
Out Patient Medical Expenses due to Grievous Injury

 Original Prescription
 Original Invoices/Bills,
 Original Payment Receipts
Note: KYC (Identity proof with Address) of the proposer, as per AML Guidelines
3. Claims Settlement: The Company shall pay interest as per Insurance Regulatory and Development
Authority of India (Protection of Policyholders’ Interests) Regulations, 2017, in case of delay in payment
of an admitted claim under the Policy
ADDITIONAL CONDITIONS
Inclusions of persons into the Group can be made on payment of additional premium on pro-rata basis
provided the cover coincides with the expiry date of the policy.
Refund of premium for deletion of persons from the Group can be made on pro-rata basis subject to there
being “No claim” in respect of such persons.
STANDARD TERMS AND CONDITIONS
(APPLICABLE TO ALL BENEFITS UNDER THIS POLICY- GROUP)
1. Incontestability and Duty of Disclosure
The Policy shall be null and void and no benefit shall be payable in the event of untrue or incorrect
statements, misrepresentation, mis-description or on non-disclosure in any material particular in the
proposal form, personal statement, declaration and connected documents, or any material information
having been withheld, or a claim being fraudulent or any fraudulent means or devices being used by the
Proposer / Group Administrator / Insured Person or any one acting on his behalf to obtain any benefit
under this Policy.
2. Observance of terms and conditions
The due observance and fulfillment of the terms, conditions and endorsement of this Policy in so far as
they relate to anything to be done or complied with by the Insured Person, shall be a condition precedent
to any liability of the Company to make any payment under this Policy.
3. Material change
The proposer / group administrator shall immediately notify the Company in writing of any change in his
business or occupation or physical defect or infirmity with which the insured person/s has become
affected.
4. Automatic Termination of Insurance
The insurance provided in respect of each relevant person insured under this policy shall automatically
terminate
 upon the Insured Person’s death or upon payment of 100% Sum Insured
 at the expiry of the period for which the premium has been paid or on the expiry date shown in the
policy schedule whichever is earlier.
5. Automatic Termination of Individual Certificate of Insurance.
Certificate of Insurance will terminate on the earliest of the following dates:
1. The date of expiry of certificate of insurance
2. The date the Insured Person is no longer eligible within the classification of Insured Person(s)
described in the Policy Schedule,
3. The Insured person ceases to be a resident of India,
4. From the date the Certificate of Insurance is cancelled either by the Company or Insured Person(s)
5. From the date on which the premium when due, is not received.( applicable only if payment is agreed
to be received in instalment)
6. Role of Group Administrator / Proposer

The Group administrator shall play a facilitative role between the Insurer and the Insured Person. Such
role includes
1. Furnish to the Company detailed list of Insured Person/s including their personal details like Gender,
Age, Date of Birth, Address etc.
2. To be a coordinator between the Company and the Insured Person in claim settlement
3. To make payment of premium on or before the stipulated time.
4. Immediately notify the Company of any change in business or occupation of the proposer or insured
entity or any physical defect or infirmity of the insured person with which the insured person becomes
affected
7. Duties of the Group Administrator / Proposer / Insured / Insured Person on occurrence of loss
On the occurrence of any loss, within the scope of cover under the Policy the Insured Person shall:
i. Forthwith file/submit a Claim Form in accordance with ‘Obligation of the Insured Person’ Clause as
provided in General Conditions.
ii. If the Insured Person does not comply with the provisions of this Clause or other obligations cast
upon the Insured Person under this Policy, in terms of the other clauses referred to herein or in terms
of the other clauses in any of the Policy documents, all benefits under the Policy shall be forfeited,
at the option of the Company.
8. Fraudulent claims
If any claim is in any respect fraudulent, or if any false statement, or declaration is made or used in support
thereof, or if any fraudulent means or devices are used by the Group Administrator / Proposer / Insured
/ Insured Person or anyone acting on his behalf to obtain any benefit under this Policy, shall be forfeited
and the policy will be cancelled without any refund of premium
6. Renewal: The Policy may be renewed with mutual consent by the payment in advance of the total
premium specified by the Company, which premium shall be in force at the time of renewal.
7. Cancellation: The Company may cancel this policy on grounds of misrepresentation, fraud, Moral
Hazard, non disclosure of material fact as declared at the inception of the policy / at the time of claim, or
non-co-operation by the insured entity, by sending the insured entity 30 days notice by registered letter to
its last known address. Where the misrepresentation, fraud, moral hazard, non disclosure either at
inception or at the time of claim is by the insured beneficiary, then the insurance cover in respect of such
insured beneficiary and his / her family will cease immediately. The insured entity may cancel this policy
and in such event the insurance cover ceases from the date of request of cancellation. Where the insured
entity requests for cancellation of the policy, the Company shall allow refund only for those insured
beneficiary who have not made claim as on the date of cancellation, after retaining premium at Company’s
short period rate only (table given below) provided no claim has occurred up to the date of cancellation.
For less than 1 year tenure policy Rate of Premium Retained: Full premium
For 1 Year Tenure Policy
Period on Risk Rate of Premium Retained
Up to 1 month 25% of the premium
Exceeding 1 month and up to 3 months 40% of the premium
Exceeding 3 months and up to 6 months 60% of the premium
Exceeding 9 months Full Premium
For 2 Year Tenure Policy (Applicable for Credit Linked Group Accident Insurance Policies)

8. Currency for payments
All claims payable shall be paid in Indian Rupee only.
9. Arbitration clause
If any dispute or difference shall arise under this Policy such dispute or difference shall independently of
all other questions be referred to the decision of a sole arbitrator to be appointed in writing by the parties
to the dispute/difference, or if they cannot agree upon a single arbitrator within 30 days of any party
invoking arbitration, the same shall be referred to a panel of three arbitrators, comprising of two arbitrators,
one to be appointed by each of the parties to the dispute/difference and the third arbitrator to be appointed
by such two arbitrators. Arbitration shall be conducted under and in accordance with the provisions of the
Arbitration and Conciliation Act, 1996.
It is hereby expressly stipulated and declared that it shall be a condition precedent to any right of action
or suit upon this Policy that the award by such arbitrator/ arbitrators of the amount of the loss or damage
shall be first obtained.
It is also further expressly agreed and declared that if the Company shall disclaim liability to the Insured
for any claim hereunder and such claim shall not, within three years from the date of such disclaimer have
been made the subject matter of a suit in a Court of Law, then the claim shall for all purposes be deemed
to have been abandoned and shall not thereafter be recoverable hereunder.
10. Important Note

a) The terms, conditions and exceptions that appear in the Policy or in any Endorsement are part of the
contract and must be complied with. Failure to comply may result in the claim being denied.
b) The Policy Schedule and any Endorsement are to be read together and any word or such meaning
wherever it appears shall have the meaning as stated in the Act / Indian Laws
c) Where the policy is issued covering the family, the benefits are applicable individually for each person
covered
d) The attention of the policy holder is drawn to our website www.starhealth.in for anti fraud policy of
the Company for necessary compliance
11. Policy Disputes: Any dispute concerning the interpretation of the terms, conditions, limitations and/or
exclusions contained herein is understood and agreed to by both the Insured and the Company to be
subject to Indian Law.
12. Notices: Any notice, direction or instruction given under this Policy shall be in writing and deliveredby
hand, post, or facsimile to Star Health and Allied Insurance Company Limited, No.1, New Tank Street,
Valluvar Kottam High Road, Nungambakkam, Chennai 600034. Customer Care No. 044-69006900 or
Toll Free No. 1800 425 2255, e-mail: [email protected]
Notice and instructions will be deemed served 7 days after posting or immediately in the case of hand
delivery, facsimile or e-mail.
13. Customer Service: If at any time the Insured Person requires any clarification or assistance, the insured
may contact No.1, New Tank Street, Valluvar Kottam High Road, Nungambakkam, Chennai 600034,
during normal business hours.
14. Redressal of Grievance: Incase of any grievance the insured person may contact the Company through
Website : www.starhealth.in
E-mail : [email protected], [email protected]
Ph. No. : 044-69006900 | Toll Free No. 1800 425 2255
Senior Citizens may call at 044-69007500
Courier : 4th Floor, Balaji Complex, No.15, Whites Lane, Whites Road, Royapettah, Chennai- 600014
lnsured person may also approach the grievance cell at any of the company's branches with the details
of grievance.
lf lnsured person is not satisfied with the redressal of grievance through one of the above methods, insured
person may contact the grievance officer at 044-43664600
For updated details of grievance officer, kindly refer the link. https://www.starhealth.in/grievance- redressal
lf lnsured person is not satisfied with the redressal of grievance through above methods, the insured
person may also approach the office of lnsurance Ombudsman of the respective area/region for redressal
of grievance as per lnsurance Ombudsman Rules 2017
Grievance may also be lodged at IRDAI lntegrated Grievance Management System -
https://bimabharosa.irdai.gov.in/
15. Nomination: The policyholder is required at the inception of the policy to make a nomination for the purpose
of payment of claims under the policy in the event of death of the policyholder. Any change of nomination
shall be communicated to the company in writing and such change shall be effective only when an
endorsement on the policy is made. For Claim settlement under reimbursement, the Company will pay the
policyholder. In the event of death of the policyholder, the Company will pay the nominee {as named in the
Policy Schedule/Policy Certificate/Endorsement (if any)} and in case there is no subsisting nominee, to the
legal heirs or legal representatives of the Policyholder whose discharge shall be treated as full and final
discharge of its liability under the Policy.
List of Ombudsman
Jurisdiction of Office
Office Details
Union Territory, District)
AHMEDABAD
Office of the Insurance Ombudsman,
Jeevan Prakash Building, 6th floor,
Gujarat, Dadra & Nagar Haveli, Daman and Diu.
Tilak Marg, Relief Road, Ahmedabad – 380 001.
Tel.: 079 - 25501201/02/05/06
Email: [email protected]
BENGALURU
Jeevan Soudha Building, PID No. 57-27-N-19
Ground Floor, 19/19, 24th Main Road, Karnataka.
JP Nagar, Ist Phase, Bengaluru – 560 078.
Tel.: 080 - 26652048 / 26652049
BHOPAL
1st floor, "Jeevan Shikha",
Madhya Pradesh
60-B, Hoshangabad Road,
Chattisgarh.
Opp. Gayatri Mandir, Bhopal – 462 011.
Tel.: 0755 - 2769201 / 2769202
BHUBANESWAR
62, Forest park, Bhubaneswar – 751 009. Odisha.
Tel.: 0674 - 2596461 /2596455
CHANDIGARH
Punjab, Haryana (excluding Gurugram, Faridabad,
S.C.O. No. 101, 102 & 103, 2nd Floor,
Sonepat and Bahadurgarh), Himachal Pradesh,
Batra Building, Sector 17 – D,
Union Territories of Jammu & Kashmir,Ladakh &
Chandigarh – 160 017.
Chandigarh.
Tel.: 0172 - 2706196 / 2706468
CHENNAI
Fatima Akhtar Court, 4th Floor, 453, Tamil Nadu, Puducherry Town and Karaikal
Anna Salai, Teynampet, Chennai – 600 018. (which are part of Puducherry).
Tel.: 044 - 24333668 / 24335284
Office Details
DELHI
2/2 A, Universal Insurance Building, Delhi & following Districts of Haryana - Gurugram,
Asaf Ali Road, New Delhi – 110 002. Faridabad, Sonepat & Bahadurgarh.
Tel.: 011 - 23232481/23213504
ERNAKULAM
2nd Floor, Pulinat Bldg., Opp. Cochin Shipyard, Kerala, Lakshadweep,
M. G. Road, Ernakulam - 682 015. Mahe-a part of Union Territory of Puducherry.
Tel.: 0484 - 2358759 / 2359338
GUWAHATI
Jeevan Nivesh, 5th Floor,
Assam, Meghalaya, Manipur, Mizoram, Arunachal
Nr. Panbazar over bridge, S.S. Road,
Pradesh, Nagaland and Tripura.
Guwahati – 781001(ASSAM).
Tel.: 0361 - 2632204 / 2602205
HYDERABAD
6-2-46, 1st floor, "Moin Court",
Lane Opp. Saleem Function Palace, Andhra Pradesh, Telangana, Yanam and part of
A. C. Guards, Lakdi-Ka-Pool, Union Territory of Puducherry.
Hyderabad - 500 004.
Tel.: 040 - 23312122
JAIPUR
Jeevan Nidhi – II Bldg., Gr. Floor,
Rajasthan.
Bhawani Singh Marg, Jaipur - 302 005.
Tel.: 0141 - 2740363
KOLKATA
Hindustan Bldg. Annexe, 7th Floor,
West Bengal, Sikkim, Andaman & Nicobar Islands.
4, C.R. Avenue, Kolkata - 700 072.
Tel.: 033 - 22124339 / 22124340
Office Details
LUCKNOW Districts of Uttar Pradesh: Lalitpur, Jhansi, Mahoba,

Office of the Insurance Ombudsman, Hamirpur, Banda, Chitrakoot, Allahabad, Mirzapur,
6th Floor, Jeevan Bhawan, Phase-II, Sonbhabdra, Fatehpur, Pratapgarh, Jaunpur,Varanasi,
Nawal Kishore Road, Hazratganj, Gazipur, Jalaun, Kanpur, Lucknow, Unnao, Sitapur,
Lucknow - 226 001. Lakhimpur, Bahraich, Barabanki, Raebareli, Sravasti,
Tel.: 0522 - 2231330 / 2231331 Gonda, Faizabad, Amethi, Kaushambi, Balrampur,
Email: [email protected] Basti, Ambedkarnagar, Sultanpur, Maharajgang,
Santkabirnagar, Azamgarh, Kushinagar, Gorkhpur,
Deoria, Mau, Ghazipur, Chandauli, Ballia,
Sidharathnagar.
MUMBAI
3rd Floor, Jeevan Seva Annexe, Goa, Mumbai Metropolitan Region (excluding Navi
S. V. Road, Santacruz (W), Mumbai - 400 054. Mumbai & Thane).
Tel.: 69038821/23/24/25/26/27/28/29/30/31
NOIDA State of Uttarakhand and the following Districts of Uttar

Office of the Insurance Ombudsman, Pradesh: Agra, Aligarh, Bagpat, Bareilly, Bijnor,
Bhagwan Sahai Palace Budaun, Bulandshehar, Etah, Kannauj, Mainpuri,
4th Floor, Main Road, Naya Bans, Sector 15, Mathura, Meerut, Moradabad, Muzaffarnagar, Oraiyya,
Distt: Gautam Buddh Nagar, U.P-201301. Pilibhit, Etawah, Farrukhabad, Firozbad, Gautam
Tel.: 0120-2514252 / 2514253 Buddh nagar, Ghaziabad, Hardoi, Shahjahanpur,
Email: [email protected] Hapur, Shamli, Rampur, Kashganj, Sambhal, Amroha,
Hathras, Kanshiramnagar, Saharanpur.
PATNA
2nd Floor, Lalit Bhawan,
Bihar, Jharkhand.
Bailey Road, Patna 800 001.
Tel.: 0612-2547068
PUNE
Jeevan Darshan Bldg., 3rd Floor,
Maharashtra, Areas of Navi Mumbai and Thane
C.T.S. No.s. 195 to 198, N.C. Kelkar Road,
(excluding Mumbai Metropolitan Region).
Narayan Peth, Pune – 411 030.
Tel.: 020-41312555
Kindly refer our website, for future updates in Ombudsman address
Items that are to be subsumed into Room Charges
SI No ITEM
1 BABY CHARGES (UNLESS SPECIFIED / INDICATED)
2 HAND WASH
3 SHOE COVER
4 CAPS
5 CRADLE CHARGES
6 COMB
7 EAU-DE-COLOGNE / ROOM FRESHNERS
8 FOOT COVER
9 GOWN
10 SLIPPERS
11 TISSUE PAPER
12 TOOTH PASTE
13 TOOTH BRUSH
14 BED PAN
15 FACE MASK
16 FLEXI MASK
17 HAND HOLDER
18 SPUTUM CUP
19 DISINFECTANT LOTIONS
20 LUXURY TAX
21 HVAC
22 HOUSE KEEPING CHARGES
23 AIR CONDITIONER CHARGES
24 IM IV INJECTION CHARGES
25 CLEAN SHEET
26 BLANKET / WARMER BLANKET
27 ADMISSION KIT
28 DIABETIC CHART CHARGES
29 DOCUMENTATION CHARGES / ADMINISTRATIVE EXPENSES
30 DISCHARGE PROCEDURE CHARGES
31 DAILY CHART CHARGES
32 ENTRANCE PASS / VISITORS PASS CHARGES

33 EXPENSES RELATED TO PRESCRIPTION ON DISCHARGE
34 FILE OPENING CHARGES
35 INCIDENTAL EXPENSES / MISC. CHARGES (NOT EXPLAINED)
36 PATIENT IDENTIFICATION BAND / NAME TAG
37 PULSEOXYMETER CHARGES
Items that are to be subsumed into Procedure Charges
SI No. ITEM
1 HAIR REMOVAL CREAM
2 DISPOSABLES RAZORS CHARGES (FOR SITE PREPARATIONS)
3 EYE PAD
4 EYE SHEILD
5 CAMERA COVER
6 DVD, CD CHARGES
7 GAUSE SOFT
8 GAUZE
9 WARD AND THEATRE BOOKING CHARGES
10 ARTHROSCOPY AND ENDOSCOPY INSTRUMENTS
11 MICROSCOPE COVER
12 SURGICAL BLADES, HARMONICSCALPEL,SHAVER
13 SURGICAL DRILL
14 EYE KIT
15 EYE DRAPE
16 X-RAY FILM
17 BOYLES APPARATUS CHARGES
18 COTTON
19 COTTON BANDAGE
20 SURGICAL TAPE
21 APRON
22 TORNIQUET
23 ORTHOBUNDLE, GYNAEC BUNDLE
Items that are to be subsumed into costs of treatment

SI No. ITEM
1 ADMISSION / REGISTRATION CHARGES
2 HOSPITALISATION FOR EVALUATION / DIAGNOSTIC PURPOSE
3 URINE CONTAINER
4 BLOOD RESERVATION CHARGES AND ANTE NATAL BOOKING CHARGES
5 BIPAP MACHINE
6 CPAP / CAPD EQUIPMENTS
7 INFUSION PUMP — COST
8 HYDROGEN PEROXIDE / SPIRIT / DISINFECTANTS ETC
9 NUTRITION PLANNING CHARGES - DIETICIAN CHARGES - DIET CHARGES
10 HIV KIT
11 ANTISEPTIC MOUTHWASH
12 LOZENGES
13 MOUTH PAINT
14 VACCINATION CHARGES
15 ALCOHOL SWABS
16 SCRUB SOLUTION / STERILLIUM
17 GLUCOMETER & STRIPS
18 URINE BAG
Schedule of Benefits
Benefit Percentage of the Sum Insured
Accidental Death – Benefit 1 100%
Permanent Total Disablement – Benefit 2
a. Sight of both eyes 100%
b. Physical separation of two entire hands 100%
c. Physical separation of two entire foot 100%
d. One entire hand and one entire foot 100%
e. Sight of one eye and loss of one hand 100%
f. Sight of one eye and loss of one entire foot 100%
g. Use of two hands 100%
h. Use of two foot 100%
i. Use of one hand and one foot 100%
j. Sight of one eye and use of one hand 100%
k. Sight of one eye and use of one foot 100%
l. Sight of one eye 50%
m. Physical separation of one entire hand 50%
n. Physical separation of one entire foot 50%
o. Use of one hand without physical separation 50%
p. Use of one foot without physical separation 50%
Loss of Foot/hand means total severance through or above the ankle/wrist joints respectively. Loss of Eye means
entire and irrevocable loss of sight.
Permanent Partial Disablement – Benefit 3

a. Loss of toes all 20%
b. Loss of Great toe (Both Phalanges) 5%
c. Loss of Great toe (One Phalanx) 2%
d. Other than Great, if more than One toe lost, for
1%
each toe
e. Loss of hearing both ears 75%
f. Loss of hearing one ear 30%
g. Loss of four fingers and thumbs of One hand 40%
h. Loss of four fingers 35%
i. Loss of thumb both phalanges (Both Phalanges) 25%
j. Loss of thumb both phalanges (One phalanx) 10%
k. Loss of index finger three phalanges 10%
l. Loss of index finger two phalanges 8%
m. Loss of index finger One phalanx 4%
n. Loss of middle finger three phalanges 6%
o. Loss of middle finger Two phalanges 4%
p. Loss of middle finger One phalanx 2%
q. Loss of ring finger Three Phalanges 5%
r. Loss of ring finger Two Phalanges 4%
s. Loss of ring finger One Phalanx 2%
t. Loss of little finger Three phalanges 4%
u. Loss of little finger Two phalanges 3%
v. Loss of little finger One phalanx 2%
w. Loss of metacarpals 3%
x. Additional (Third, fourth or fifth ) 2%
Percentage as assessed by the Medical Board or
y. Any other Permanent partial disablement
by the government doctor
Loss of Thumb or index finger means actual severance through or above the joint that meets the hand at the
palm.

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STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITED

GROUP ACCIDENT INSURANCE POLICY

Exclusions (applicable to all Benefits)

This amount is payable in addition to the sum insured

 Police Investigation report / Panchanama (wherever required)

Out Patient Medical Expenses due to Grievous Injury

6. Role of Group Administrator / Proposer

Exceeding 39 months and up to 42 months 90% of the premium

10. Important Note

LUCKNOW Districts of Uttar Pradesh: Lalitpur, Jhansi, Mahoba,

NOIDA State of Uttarakhand and the following Districts of Uttar

Kindly refer our website, for future updates in Ombudsman address

Items that are to be subsumed into Room Charges

32 ENTRANCE PASS / VISITORS PASS CHARGES

Items that are to be subsumed into Procedure Charges

Items that are to be subsumed into costs of treatment

Permanent Partial Disablement – Benefit 3

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